Impacts of an Electronic Health Record Transition on Veterans Health Administration Health Professions Trainee Experience

Abstract

Abstract Background Adoption of electronic health care records (EHRs) has proliferated since 2000. While EHR transitions are widely understood to be disruptive, little attention has been paid to their effect on health professions trainees’ (HPTs) ability to learn and conduct work. Veterans Health Administration’s (VA) massive transition from its homegrown EHR (CPRS/Vista) to the commercial Oracle Cerner presents an unparalleled-in-scope opportunity to gain insight on trainee work functions and their ability to obtain requisite experience during transitions. Objective To identify how an organizational EHR transition affected HPT work and learning at the third VA go-live site. Design A formative mixed-method evaluation of HPT experiences with VHA’s EHR transition including interviews with HPTs and supervisors at Chalmers P. Wylie VA Outpatient Clinic in Columbus, OH, before (~60 min), during (15–30 min), and after (~60 min) go-live (December 2021–July 2022). We also conducted pre- (March 2022–April 2022) and post-go live (May 2022–June 2022) HPT and employee surveys. Participants We conducted 24 interviews with HPTs (n=4), site leaders (n=2), and academic affiliates (n=2) using snowball sampling. We recruited HPTs in pre- (n=13) and post-go-live (n=10) surveys and employees in pre- (n=408) and post-go-live (n=458) surveys. Approach We conducted interviews using a semi-structured guide and grounded prompts. We coded interviews and survey free text data using a priori and emergent codes, subsequently conducting thematic analysis. We conducted descriptive statistical analysis of survey responses and merged interview and survey data streams. Key Results Our preliminary findings indicate that the EHR transition comprehensively affected HPT experiences, disrupting processes from onboarding and training to clinical care contributions and training-to-career retention. Conclusions Understanding HPTs’ challenges during EHR transitions is critical to effective training. Mitigating the identified barriers to HPT training and providing patient care may lessen their dissatisfaction and ensure quality patient care during EHR transitions.